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Mini Pathria Michael Zlatkin Richard Rick G Stiles - PowerPoint PPT Presentation


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1986-1987. Mini Pathria Michael Zlatkin Richard (Rick) G Stiles. Mini Pathria. Middle-aged male Hx of recent knee trauma. Case 1. Middle-aged male Hx of recent knee trauma. Radiographs. Sagittal. Coronal. Axial. Thigh. Differential diagnosis. Neurofibromatosis

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1986 1987
1986-1987
  • Mini Pathria
  • Michael Zlatkin
  • Richard (Rick) G Stiles
mini pathria
Mini Pathria
  • Middle-aged male
  • Hx of recent knee trauma
case 1
Case 1
  • Middle-aged male
  • Hx of recent knee trauma
differential diagnosis
Differential diagnosis
  • Neurofibromatosis
  • Melorheostosis with soft tissue component
neurofibromatosis
Neurofibromatosis
  • Further history obtained
    • Skin nodules
    • Neurofibromas on cranial CT 7 years previously (not acoustic neuroma)
case 2
Case 2
  • Middle-aged female with thigh mass
follow up
Follow-up
  • Mass biopsied, benign plexiform neurofibroma
  • Patient developed hip pain
neurofibromatosis1
Neurofibromatosis
  • Plexiform neurofibroma at biopsy
  • No evidence of malignancy
case 3
Case 3
  • 40 year old male with slowly growing painless mass
plexiform neurofibroma1
Plexiform neurofibroma
  • Specific finding for NF1 (peripheral form)
  • 5% of patients with NF1
  • Approximately 5-10% degenerate to neurosarcoma

courtesy of Mark Murphey, AFIP

neurofibroma
Neurofibroma
  • Localized
  • Diffuse
  • Plexiform
    • Well-defined
    • Bag of worms
    • Infiltrating
elephantiasis neurofibromatosa
Elephantiasis neurofibromatosa
  • Diffuse form of plexiform neurofibroma
  • Overgrowth of epidermal and subcutaneous tissue
  • Wrinkled and pendulous appearance
michael b zlatkin and alfredo arraut nmsi
Michael B. Zlatkin and Alfredo Arraut NMSI
  • 27 year old male involved in a motor vehicle accident
findings
Findings
  • Subscapularis tendon is avulsed with bone from the lesser tuberosity
  • Humeral avulsion of the anterior band of the glenohumeral ligament (HAGL)
  • Middle glenohumeral ligament and possibly the superior glenohumral ligament may be avulsed as well
  • Possible reverse Hill-Sachs lesion
subscap rupture and hagl bhagl
Subscap Rupture and HAGL (BHAGL)
  • Rupture of the subscapularis tendon uncommon but can be seen in younger patients injured by forced external rotation or extension of a partially abducted arm
  • Tears occur near insertion on the lesser tub. May occur at sup margin, where tendon may be weakened by degeneration
  • Avulsion fracture of the lesser tuberosity may occur, and is displaced medially and inferiorly
  • Subscapularis avulsions are also associated with injury to the anterior capsule and glenohumeral ligaments (HAGL)
  • When the AIGHL avulses a fragment of bone from the humerus, the lesion is known as a bony HAGL, or BHAGL
  • ? With MGHL and SGHL torn = Super BHAGL
michael b zlatkin and alfredo arraut nmsi1
Michael B. Zlatkin and Alfredo Arraut NMSI
  • 17 year old male with bony growth on the dorsum of hand
findings1
Findings
  • Bone prominence on the dorsum of the hand between the trapezoid, capitate, and bases of the 2nd and 3rd metacarpals
  • Associated with base of 3rd metacarpal, but no marrow continuity with it
  • Sclerosis and cystic change at junction with 3rd metacarpal base
carpal boss
Carpal Boss
  • Bone protuberance on dorsum of the hand
  • Degenerative osteophyte or os styloideum
  • Located between trapezoid, capitate, and base of 2nd and 3rd metacarpals
  • Most often fused to a metacarpal base, but rarely (2%) can be completely isolated
  • Symptoms caused by degeneration, formation of ganglion or bursa, or snapping of an extensor tendon moving over it
carpal boss1
Carpal Boss
  • Can be demonstrated on lateral radiograph with hand flexed and supinated 30-40 degrees; best seen with mild ulnar deviation
  • Alternatively can image with CT or MR
  • MR can demonstrate marrow edema in the carpal boss and surrounding soft tissue changes
carpal boss companion case
Carpal Boss – Companion Case

Carpal boss fused to base of third metacarpal with edema in overlying soft tissues

carpal boss companion case1
Carpal Boss - Companion Case

Carpal boss fused to third metacarpal with fracture at its base

carpal boss companion case2
Carpal Boss – Companion Case

Surface rendering of carpal boss with fracture at its base

michael b zlatkin and alfredo arraut nmsi2
Michael B. Zlatkin and Alfredo Arraut NMSI
  • 33 year old professional hockey player with pain in the flank after practice
findings2
Findings
  • Partial thickness tear of the internal oblique muscle belly proximally, with surrounding edema and hematoma
  • Fluid tracking between internal and external obliques
  • Feathery pattern of edema at the more distal aspect of the internal oblique
side strain
Side Strain
  • Uncommon sporting injury presenting with pain and tenderness over anterolateral and posterolateral lower ribcage
  • Associated with cricket, golf, and ice hockey – eccentric contraction of trunk muscles
  • Partial or complete tear of lateral abdominal wall musculature (internal oblique > external oblique > transversus abdominis)
  • May also see avulsion at the muscular origins from the lower ribs
  • Recovery takes 6-10 weeks. Full recovery is the norm
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